[Ophthalmodynamometry in the diagnostics of Grave's ophthalmopathy].

BACKGROUND: Since endocrine orbitopathy is characterised by exophthalmos and increased orbital tissue pressure which may lead to a compression of and damage to the optic nerve, it was the purpose of this study to evaluate whether the increased orbital tissue pressure in endocrine orbitopathy is associated with an elevated central retinal vein pressure as estimated by ophthalmodynamometry, and whether the central retinal vein pressure changes in the course of the disease.

PATIENTS AND METHODS: The prospective clinical study included 7 patients (13 eyes) with endocrine orbitopathy. They were screened for the prevalence of a spontaneous pulsation of the central retinal vein. In case of a missing spontaneous pulse, the collapse pressure of the central retinal vein was estimated by a modified ophthalmodynamometry using a corneal contact lens associated ophthalmodynamometric device. A group of 122 patients (156 eyes) without orbital or retinal diseases served as control group.

RESULTS: The frequency of a spontaneous pulse of the central retinal vein was significantly lower in the study group (1/13 or 8%) than in the control group (121/156 or 78% p<0.001; odds ratio: 41.5). The central retinal vein collapse pressure as determined by ophthalmodynamometry was significantly higher in the study group (22.7+/-19.5 arbitrary units) than in the control group (4.7+/-12.8 arbitrary units) (p=0.002). For one patient with 7 examinations during a follow-up of 16 months, the central retinal vein pressure increased from 17 arbitrary units to 56 units, and decreased to 14 to 19 arbitrary units after initiation of a systemic therapy and regression of the exophthalmos. Three years later a spontaneous pulsation of the central retinal vein was detectable.

CONCLUSION: Ophthalmodynamometry may be a useful examination for the indirect assessment of the orbital tissue pressure in patients with endocrine orbitopathy.